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Volume 14
Issue 19
10.3390/jcm14196993
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Review

Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair

by
Waël Oweini
1,
Jalal Jolou
2,
Tornike Sologashvili
2,
Nicolas Murith
2,
Christoph Huber
2 and
Mustafa Cikirikcioglu
2,*
1
Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland
2
Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(19), 6993; https://doi.org/10.3390/jcm14196993
Submission received: 19 August 2025 / Revised: 19 September 2025 / Accepted: 27 September 2025 / Published: 2 October 2025
(This article belongs to the Special Issue Aortic Aneurysms: Recent Advances in Diagnosis and Treatment)
Versions Notes

Abstract

The aorta, once viewed as a passive conduit, is now recognized as an active organ crucial for hemodynamic regulation and vascular homeostasis. Thoracic aortic aneurysms (TAAs), particularly those involving the ascending aorta, often remain silent until life-threatening complications such as dissection or rupture occur. Current management primarily relies on aortic diameter criteria, yet up to 60% of type A dissections occur at sizes below the 5.5 cm surgical threshold, revealing the limitations of this approach. This narrative review summarizes recent advances in understanding ascending aortic aneurysms, including insights into their genetic and degenerative mechanisms, the role of novel morphological and hemodynamic markers, and the potential of advanced imaging techniques. It also explores evolving surgical strategies, from conventional open repair, still the gold standard, to minimally invasive and investigational endovascular approaches. By integrating biological, morphological, and clinical factors, emerging strategies aim to move beyond diameter alone toward more personalized risk assessment. This paradigm shift may improve early detection, optimize surgical timing, and ultimately enhance outcomes for patients with ascending aortic aneurysms.
Keywords: ascending aorta aneurysm; thoracic aortic disease; surgical thresholds; vascular imaging; genetic aortopathy ascending aorta aneurysm; thoracic aortic disease; surgical thresholds; vascular imaging; genetic aortopathy

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MDPI and ACS Style

Oweini, W.; Jolou, J.; Sologashvili, T.; Murith, N.; Huber, C.; Cikirikcioglu, M. Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair. J. Clin. Med. 2025, 14, 6993. https://doi.org/10.3390/jcm14196993

AMA Style

Oweini W, Jolou J, Sologashvili T, Murith N, Huber C, Cikirikcioglu M. Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair. Journal of Clinical Medicine. 2025; 14(19):6993. https://doi.org/10.3390/jcm14196993

Chicago/Turabian Style

Oweini, Waël, Jalal Jolou, Tornike Sologashvili, Nicolas Murith, Christoph Huber, and Mustafa Cikirikcioglu. 2025. "Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair" Journal of Clinical Medicine 14, no. 19: 6993. https://doi.org/10.3390/jcm14196993

APA Style

Oweini, W., Jolou, J., Sologashvili, T., Murith, N., Huber, C., & Cikirikcioglu, M. (2025). Ascending Aortic Aneurysms: From Pathophysiology to Surgical Repair. Journal of Clinical Medicine, 14(19), 6993. https://doi.org/10.3390/jcm14196993

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